Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2023

An ecological assessment of health system performance, universal health coverage, and socio-cultural factors associated with progress towards cervical cancer elimination targets (#83)

Amelia Hyatt 1 2 3 4 , Karen Canfell 5 , Rob Moodie 4 , Sanchia Aranda 3
  1. Peter MacCallum Cancer Centre/University of Melbourne, Coburg, VICTORIA, Australia
  2. Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
  3. Department of Nursing, University of Melbourne, Melbourne, VIC, Australia
  4. School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
  5. Daffodil Centre, University of Sydney, Sydney, NSW, Australia

Aims

In 2020, the World Health Organisation launched the strategy for the global elimination of cervical cancer comprising three targets for vaccination, screening, and treatment. However, many nations face a range of social, political, and economic barriers which impact effective implementation and scale-up of cervical cancer programs needed to achieve these targets. This study therefore used a cross-sectional ecological approach to investigate health system factors associated with successful progress towards cervical cancer elimination targets, to better inform policy and optimise health system performance and planning.

Methods

Four established conceptual frameworks describing the social determinants of health, WHO building blocks of health system performance, universal health coverage, and cervical cancer elimination were analysed to determine core domains appropriate for measurement. Indicators which provide direct or indirect measurement of these domains were identified in publicly available global datasets. Descriptive statistics, and Kendall’s Tau and Pearson’s r were employed to describe and measure the strength of association between indicators and progress towards WHO elimination targets.

Results

A total of 155 countries were included in the analysis, with data from 62 indicators analysed. Descriptive analysis demonstrated that overall, progress towards the 2030 elimination targets is being made, however, there are significant disparities across WHO regions. Indicators measuring contextual factors associated with the social determinants of health such as democratic governmental systems and macroeconomic, social and public policies focusing on improved equity all had large associations with successful progress towards cervical cancer elimination. Increased access to healthcare via universal health coverage, optimal service delivery, health workforce availability, robust health information systems and increased health financing were likewise associated with country level progress towards all elimination targets.

Conclusions

Economic, political, socio-cultural, health system function and coverage factors are associated with the successful implementation and scale up of cervical cancer elimination programs. Policy and health system strengthening opportunities exist to improve global progress towards cervical cancer elimination.